Great News!

We FINALLY have internet at our guest house...hope this lasts! While I prepare my next post, please look at my friends' blogs listed on the righthand side of the screen :)

L to R: Katherine, Me, Elisabeth...with the Himalayas!

Beautiful Namobuddha.

Friday, February 10, 2012

Another great day at Dhulikhel hospital. We had an awesome teaching session with one of the hospital’s cardiologists. One of his patients was there, a 44 yo woman with documented rheumatic heart disease (this is a complication of untreated streptococcal infections- like strep throat causing vegetations on valves leading to heart failure, etc) and he taught us about this condition by having us ask questions about her presenting signs/symptoms, examine her and then watch as he performed an echocardiogram! It was so cool to see the valvular dysfunction that this condition had caused first hand. This is an extremely rare disease to see manifested in the United States because we treat strep throat (even when we don’t have 100% proof that an infection exists). In a developing nation like Nepal, patient education and access to healthcare (among many others) are some issues contributing to nation’s population acquiring this very preventable disease.

Saturday, Feb 11th, 2012

We took a day trek to the beautiful Namobuddha, a destination that is about 3 hours away by foot. Legend has it that years ago at the current site of this stupa, a Buddhist discovered a starving tigress that couldn’t feed her cubs and so he sacrificed himself and was thus transported to a higher realm of existence. The hike was great...intense for me considering I have not hiked longer than 2-3 hours at once (we left at 9am and got back at 5:30pm!). I loved every minute...this was no lazy Saturday! We trekked the mountainside, passing several quaint villages with baby goats, chickens, cows and people greeting us along the way. After 3.5 hours, reached Namobhudda- with prayer flags painting the sky, small prayer areas filled with hundreds of candles (I got to light one!) and beautiful painted pillars describing the experience the Buddhist had as he sacrificed himself and reached Nirvana. We got to see another beautiful monastery too and got to listen to monks playing instruments and singing chants in Tibetan- very cool. It was a wonderful Saturday and our buns and thighs are aching- totally worth it! Loving Nepal, day by day. Talk to you soon, xoxo.

So much has happened since my last post…I apologize to those of you who have been waiting so desperately for an update (hehe)! We thought we struck gold when Katherine got a wifi password to the hospital’s source but we are still having major issues in connecting.

**warning: some mild medical jargon and/or descriptions of unpleasant or unsettling things may be used below (or in any further posts).

A typical work day at the hospital is as follows: 8am morning report, 8:20 break for tea, 9am rounds in respective departments (this part is tricky- we haven’t really been assigned yet because our first 2 weeks revolve around tropical medicine lectures and the 2^nd 2 weeks will be more clinical), 10:30 am lecture, at noon we break for lunch to beat the rush of the 1pm hospital-wide lunch break, 2pm lecture, 3:30 more tea, and at 4:30 we’re usually on our way back to the hostel to relax before dinner. This may sound extremely laid back but a lot of our time and some frustration is spent figuring out what/when/where exactly we’re supposed to be doing thing.

The lovely part is that everyone has been very receptive and flexible. These difficulties and frustrations we’re facing are to be expected considering we are guinea pigs in establishing this international rotation

On Wednesday we took a field trip to the Nepal Tuberculosis Centre and Bir, the oldest government-run hospital in Nepal. The TB center is actually just a place where patients who were diagnosed/suspected of TB in the community are referred to for confirmatory testing, teaching materials and information on where to receive their DOTS treatment. DOTS: Directly Observed Treatment Schedule- designed for countries like Nepal to keep track of the masses of people infected with TB and how they’re adhering to their treatment. As you can imagine, after starting treatment for TB, patients start to feel great and they stop taking their medications…leading to the infection not being cleared and on a larger scale- scary multi-drug resistant forms of TB. The second hospital site, Bir, is a 400 bed hospital with every department imaginable. It is so very different than the fairly new, clean, controlled environment of Dhilikhel hospital. In addition to ill-lit corridors, there is a distinct smell of urine and feces emanating from Bir. On the other hand, the hospital has designed a pretty sophisticated waste management program providing many functions from autoclaving & selling many of the used containers (which makes money for the hospital considering 50% of the patients cannot pay for their care) to production of fertilizer made by worms that digest used gauze and bandages. Sounds crazy but the Nepali people are aware of their resources (or lack there of) and come up with clever ways to improve their situation.

Thursday was fantastic! We traveled 1.5 hours from Dhulikhel to a village outpost. The mountainside road we traveled by truck was interesting to say the least. You might be aware of my anxiety when driving in less than perfect conditions…let’s just say I was put to the test today. When on the road, one would think there would be no way more than one car could fit on it, but SURPRISE, we were playing chicken with buses and trucks around blind corners. After a while, I just shut my eyes and pretended it wasn’t happening.

The outpost was surprisingly well-equipped and clean. There was a common room where new patients were seen and inpatients were kept, a procedure room, a lab and a room outfitted with stirrups, for gyn exams and deliveries. We got to see about 10 patients with the medical officer (resident) ranging from a woman with an axillary mass to another woman coming in with shoulder pain and decreased range of motion. Most of the patients we saw had to be referred to Dhulikhel hospital d/t a lack of resources(ex. 44 yo female with 1 month vaginal bleeding sent to D hospital for further imaging/workup, 5 yo boy with phimosis- when the foreskin become unretractable in an uncircumsized male, he will have to go under anesthesia and have a circumcision performed). The outpost’s staff prepared a great meal for us too. I felt at home during our outpost visit…I’m not sure if it was because I was finally seeing/examining patients or because the problems that the Nepali people face are so similar to the problems presented by my fellow Americans in my favorite environment- the family medicine clinic! Just a thought. More to come, xoxo.

So much has happened since my last post…I apologize to those of you who have been waiting so desperately for an update (hehe)! We thought we struck gold when Katherine got a wifi password to the hospital’s source but we are still having major issues in connecting.

**warning: some mild medical jargon and/or descriptions of unpleasant or unsettling things may be used below (or in any further posts).

A typical work day at the hospital is as follows: 8am morning report, 8:20 break for tea, 9am rounds in respective departments (this part is tricky- we haven’t really been assigned yet because our first 2 weeks revolve around tropical medicine lectures and the 2^nd 2 weeks will be more clinical), 10:30 am lecture, at noon we break for lunch to beat the rush of the 1pm hospital-wide lunch break, 2pm lecture, 3:30 more tea, and at 4:30 we’re usually on our way back to the hostel to relax before dinner. This may sound extremely laid back but a lot of our time and some frustration is spent figuring out what/when/where exactly we’re supposed to be doing thing.

The lovely part is that everyone has been very receptive and flexible. These difficulties and frustrations we’re facing are to be expected considering we are guinea pigs in establishing this international rotation

On Wednesday we took a field trip to the Nepal Tuberculosis Centre and Bir, the oldest government-run hospital in Nepal. The TB center is actually just a place where patients who were diagnosed/suspected of TB in the community are referred to for confirmatory testing, teaching materials and information on where to receive their DOTS treatment. DOTS: Directly Observed Treatment Schedule- designed for countries like Nepal to keep track of the masses of people infected with TB and how they’re adhering to their treatment. As you can imagine, after starting treatment for TB, patients start to feel great and they stop taking their medications…leading to the infection not being cleared and on a larger scale- scary multi-drug resistant forms of TB. The second hospital site, Bir, is a 400 bed hospital with every department imaginable. It is so very different than the fairly new, clean, controlled environment of Dhilikhel hospital. In addition to ill-lit corridors, there is a distinct smell of urine and feces emanating from Bir. On the other hand, the hospital has designed a pretty sophisticated waste management program providing many functions from autoclaving & selling many of the used containers (which makes money for the hospital considering 50% of the patients cannot pay for their care) to production of fertilizer made by worms that digest used gauze and bandages. Sounds crazy but the Nepali people are aware of their resources (or lack there of) and come up with clever ways to improve their situation.

Thursday was fantastic! We traveled 1.5 hours from Dhulikhel to a village outpost. The mountainside road we traveled by truck was interesting to say the least. You might be aware of my anxiety when driving in less than perfect conditions…let’s just say I was put to the test today. When on the road, one would think there would be no way more than one car could fit on it, but SURPRISE, we were playing chicken with buses and trucks around blind corners. After a while, I just shut my eyes and pretended it wasn’t happening.

The outpost was surprisingly well-equipped and clean. There was a common room where new patients were seen and inpatients were kept, a procedure room, a lab and a room outfitted with stirrups, for gyn exams and deliveries. We got to see about 10 patients with the medical officer (resident) ranging from a woman with an axillary mass to another woman coming in with shoulder pain and decreased range of motion. Most of the patients we saw had to be referred to Dhulikhel hospital d/t a lack of resources(ex. 44 yo female with 1 month vaginal bleeding sent to D hospital for further imaging/workup, 5 yo boy with phimosis- when the foreskin become unretractable in an uncircumsized male, he will have to go under anesthesia and have a circumcision performed). The outpost’s staff prepared a great meal for us too. I felt at home during our outpost visit…I’m not sure if it was because I was finally seeing/examining patients or because the problems that the Nepali people face are so similar to the problems presented by my fellow Americans in my favorite environment- the family medicine clinic! Just a thought. More to come, xoxo.

So much has happened since my last post…I apologize to those of you who have been waiting so desperately for an update (hehe)! We thought we struck gold when Katherine got a wifi password to the hospital’s source but we are still having major issues in connecting.

**warning: some mild medical jargon and/or descriptions of unpleasant or unsettling things may be used below (or in any further posts).

A typical work day at the hospital is as follows: 8am morning report, 8:20 break for tea, 9am rounds in respective departments (this part is tricky- we haven’t really been assigned yet because our first 2 weeks revolve around tropical medicine lectures and the 2^nd 2 weeks will be more clinical), 10:30 am lecture, at noon we break for lunch to beat the rush of the 1pm hospital-wide lunch break, 2pm lecture, 3:30 more tea, and at 4:30 we’re usually on our way back to the hostel to relax before dinner. This may sound extremely laid back but a lot of our time and some frustration is spent figuring out what/when/where exactly we’re supposed to be doing thing.

The lovely part is that everyone has been very receptive and flexible. These difficulties and frustrations we’re facing are to be expected considering we are guinea pigs in establishing this international rotation

On Wednesday we took a field trip to the Nepal Tuberculosis Centre and Bir, the oldest government-run hospital in Nepal. The TB center is actually just a place where patients who were diagnosed/suspected of TB in the community are referred to for confirmatory testing, teaching materials and information on where to receive their DOTS treatment. DOTS: Directly Observed Treatment Schedule- designed for countries like Nepal to keep track of the masses of people infected with TB and how they’re adhering to their treatment. As you can imagine, after starting treatment for TB, patients start to feel great and they stop taking their medications…leading to the infection not being cleared and on a larger scale- scary multi-drug resistant forms of TB. The second hospital site, Bir, is a 400 bed hospital with every department imaginable. It is so very different than the fairly new, clean, controlled environment of Dhilikhel hospital. In addition to ill-lit corridors, there is a distinct smell of urine and feces emanating from Bir. On the other hand, the hospital has designed a pretty sophisticated waste management program providing many functions from autoclaving & selling many of the used containers (which makes money for the hospital considering 50% of the patients cannot pay for their care) to production of fertilizer made by worms that digest used gauze and bandages. Sounds crazy but the Nepali people are aware of their resources (or lack there of) and come up with clever ways to improve their situation.

Thursday was fantastic! We traveled 1.5 hours from Dhulikhel to a village outpost. The mountainside road we traveled by truck was interesting to say the least. You might be aware of my anxiety when driving in less than perfect conditions…let’s just say I was put to the test today. When on the road, one would think there would be no way more than one car could fit on it, but SURPRISE, we were playing chicken with buses and trucks around blind corners. After a while, I just shut my eyes and pretended it wasn’t happening.

The outpost was surprisingly well-equipped and clean. There was a common room where new patients were seen and inpatients were kept, a procedure room, a lab and a room outfitted with stirrups, for gyn exams and deliveries. We got to see about 10 patients with the medical officer (resident) ranging from a woman with an axillary mass to another woman coming in with shoulder pain and decreased range of motion. Most of the patients we saw had to be referred to Dhulikhel hospital d/t a lack of resources(ex. 44 yo female with 1 month vaginal bleeding sent to D hospital for further imaging/workup, 5 yo boy with phimosis- when the foreskin become unretractable in an uncircumsized male, he will have to go under anesthesia and have a circumcision performed). The outpost’s staff prepared a great meal for us too. I felt at home during our outpost visit…I’m not sure if it was because I was finally seeing/examining patients or because the problems that the Nepali people face are so similar to the problems presented by my fellow Americans in my favorite environment- the family medicine clinic! Just a thought. More to come, xoxo.

Namaste, my friends and loved ones! Sorry for the delay, but internet in Dhulikhel is hard to come by...and a bit of bad news- uploading pics is nearly impossible!

We arrived in Dhulikhel on Sunday evening and what a change of scenery compared to KTM! Here, the Himalayas are clear as day and paint the sky during our short walk to and from our amazing hospital. Everyone has welcomed us warmly and our first clinic day yesterday was great!

After clinic we went for a breath-taking hike to a look-out and as the sun went down the snowy tops of the Himalayas took on a champagne pink glow- absolutely stunning. We ate at a wonderful restaurant near our hostel (sharing a room and bathroom with the one and only Katherine Gavin!) and we each paid roughly 300 Nepali Rupees= $4 USD!!

That is all for now...I will update as much as I can!!! xoxo